Dollar D
Development Research Group, The World Bank, 1818 H Street NW, Washington, DC 20433, USA.
Bull World Health Organ. 2001;79(9):827-33. Epub 2001 Oct 23.
Four points are made about globalization and health. First, economic integration is a powerful force for raising the incomes of poor countries. In the past 20 years several large developing countries have opened up to trade and investment, and they are growing well--faster than the rich countries. Second, there is no tendency for income inequality to increase in countries that open up. The higher growth that accompanies globalization in developing countries generally benefits poor people. Since there is a large literature linking income of the poor to health status, we can be reasonably confident that globalization has indirect positive effects on nutrition, infant mortality and other health issues related to income. Third, economic integration can obviously have adverse health effects as well: the transmission of AIDS through migration and travel is a dramatic recent example. However, both relatively closed and relatively open developing countries have severe AIDS problems. The practical solution lies in health policies, not in policies on economic integration. Likewise, free trade in tobacco will lead to increased smoking unless health-motivated disincentives are put in place. Global integration requires supporting institutions and policies. Fourth, the international architecture can be improved so that it is more beneficial to poor countries. For example, with regard to intellectual property rights, it may be practical for pharmaceutical innovators to choose to have intellectual property rights in either rich country markets or poor country ones, but not both. In this way incentives could be strong for research on diseases in both rich and poor countries.
关于全球化与健康,有以下四点。第一,经济一体化是提高穷国收入的强大力量。在过去20年里,几个大型发展中国家开放了贸易和投资,并且发展良好——比富国发展得更快。第二,开放的国家不存在收入不平等加剧的趋势。发展中国家全球化带来的更高增长通常使穷人受益。由于有大量文献将穷人的收入与健康状况联系起来,我们可以合理地相信全球化对营养、婴儿死亡率以及其他与收入相关的健康问题有间接的积极影响。第三,经济一体化显然也会对健康产生不利影响:通过移民和旅行传播艾滋病就是最近一个显著的例子。然而,相对封闭和相对开放的发展中国家都存在严重的艾滋病问题。实际的解决办法在于卫生政策,而非经济一体化政策。同样,烟草自由贸易将导致吸烟人数增加,除非实施出于健康考虑的抑制措施。全球一体化需要配套的制度和政策。第四,可以改进国际架构,使其对穷国更有利。例如,在知识产权方面,制药创新者可能选择在富国市场或穷国市场拥有知识产权,但不是两者都有。这样一来,对富国和穷国疾病研究的激励都可能很强。